Barriers to Advance Care Planning (ACP) in the Hospital: A Review and Case Study
While the importance of advance care planning (ACP) and the role that hospitalists play is clear, there are numerous barriers that prevent better, earlier, and more frequent ACP. Many hospitalists find ACP and goals of care conversations uncomfortable. Some physicians feel that broaching the ACP conversation constitutes giving up hope for the patient. This is often reinforced by family members. Hospitalists have noted that the lack of long-standing relationship with hospitalized patients makes ACP conversations difficult to broach. The demands of hospital throughput often make establishing a mutually respectful relationship challenging. Families and patients who are not ready to talk about death and end-of-life care can make ACP feel even more uncomfortable and difficult. In this chapter case studies are reviewed to determine barriers to ACP.
